Ensuring health and human rights for ageing population

Older persons do not constitute a homogenous group, and the challenges they face usually vary greatly. While some continue to lead active lives as part of their community, many others face homelessness, lack of adequate care or downright isolation

The term ‘senior citizen’ commonly denotes an old and usually retired person and is usually employed to determine the eligibility for certain benefits available to the age group ranging from 60-65 years and beyond. Currently, after increasing at an unprecedented pace, the number of persons aged 60 and over is close to one billion worldwide, roughly coinciding with a 2012 UNFPA estimate that older people comprised around 12 percent of the global population. This rapid increase has also exposed the lack of adequate protection mechanisms, and existing gaps in policies and programs to address or mitigate the situation of older persons. Two-thirds of the world’s older people currently live in low-and middle-income countries such as Pakistan. The proportion of people of 65 years and above in the country is 3.72 percent totaling nearly 8 million people, while the proportion of people over 60 or 62 is obviously higher.

Older persons do not constitute a homogenous group, and the challenges they face usually vary greatly. While some continue to lead active lives as part of their community, many others face homelessness, lack of adequate care or downright isolation. There is presently no international convention on the rights of older people along the lines of those for children (CRC) or women (CEDAW). Thus, there are neither sufficient mechanisms to adequately protect the human rights of older people, nor legal standards that challenge the existing adverse attitudes and provide an effective framework for policy and decision-making amidst major challenges such as financial exploitation, employment discrimination, adequate care facilities and/or participation in political life. Several interventions have nevertheless materialized in this direction mostly benefiting people in developed countries.

On a global level, the first ever World Assembly on Ageing in 1982 in Vienna, developed the Vienna International Plan of Action on Ageing, constituting the first set of guidelines for different stakeholders to help society adapt to population ageing. The Vienna Plan included many pertinent recommendations for fact finding, research, capacity building, data collection and awareness creation with the collaboration of the health, nutrition, housing, environment, family, social welfare, income security and employment sectors.

Subsequently, the United Nations developed the UN Principles for Older Persons, mandating that “older persons should have access to health care to help them to maintain or regain the optimum level of physical, mental and emotional well-being and to prevent or delay the onset of illness.” The World Health Organization(WHO) also focused on the health problems of the elderly devising recommendations to support them amidst rapid population growth.

Elderly citizens are a precious resource for any country, and efforts must be made to tap and harness their skills, maturity and experience in resolving the major problems confronting the nation, province, district or local communities

The Second World Assembly on Ageing in Madrid, 2002, evaluated the achievements promoted by the Vienna Plan and established some more relevant goals, offering a new agenda for handling the issue of aging in the 21st-century. It focused on three priorities aimed at inclusion and participation of the targeted population and underlined mainly social measures for the elderly, while emphasizing on scientific research on age-related diseases to develop new and affordable treatments and rehabilitation programs. The Madrid Plan has since been reinforced by the United Nations Open-ended Working Group (OEWG) on Ageing in 2010, followed by the World Health Organization’s Global strategy and action plan on Ageing and Health (2016) read with the relevant Sustainable Development Goals, agreed to by the entire international community including Pakistan.

The United Nations High Commissioner for Human Rights also strives to ensure that neglected population groups are given space in the human rights agenda, while other international instruments applicable to elderly people include the International Covenant on Civil and Political Rights (ICCPR) and the International Covenant on Economic Social and Cultural Rights (ICESCR), as well as regional human rights conventions.

In Pakistan, the average life expectancy at birth was less than 57 years in 1985, however in 2015 WHO estimated it at 66.4 (males 65.5 and females 67.5) with a rank of 130 amongst 183 nations. This improvement over three decades, though relatively modest, came about due to a combination of several factors, from improved medical facilities to more highly skilled professionals in health cadres and addressing the causes of child mortality to the control of communicable diseases with a somewhat improved environment. It is estimated that at 3.72 percent of the population, there are close to 8 million persons living in Pakistan with an age of 65 years or more. This is incidentally the only age group with a majority of females in Pakistan.

Hitherto fore, not much headway has been made in the country and only insignificant sporadic gestures have emerged in this important area. In the absence of either sufficient legislation or the operational mechanisms to implement them, the concessions for senior citizens are few and mostly symbolic with little tangible relief offered to ensure their meaningful inclusiveness and participation in any province of Pakistan.

Perhaps a solitary exception is a recent ministerial announcement that Pakistan Railways will give 50 percent reduction in fares to people 65 and above and make it totally free for people over 75 years. Although it is not certain if the announcement has been implemented, it is definitely a step in the right direction. The public and private health, housing aviation, transport, entertainment and food and beverage sectors need to take similar steps through a holistic and integrated approach, in addition to making facilities user-friendly by construction of ramps for the disabled, geriatric care facilities and generally an enabling environment to cope with old age

Pakistan, that has a high population growth rate of 2.4 percent with increasing life expectancy would do well to increase its commitment and complete the groundwork for the ageing population segment to prevent it from growing into a major problem of massive proportions. The country also needs to fulfill its international obligations as a signatory of the Madrid Plan of Action on Ageing and the Sustainable Development Goals to ensure that there is no financial exploitation of the elderly and a suitable welfare mechanism is in place for them entailing post retirement subsistence and/or pension with free medical treatment of an acceptable quality. Care provision for non communicable diseases such as cancers, diabetes, strokes, chronic respiratory diseases, cardiovascular diseases and psychosocial support for mental health problems merits a high priority being the major ailments in this age group.

Elderly citizens are a precious resource for any country, and efforts must be made to tap and harness their skills, maturity and experience in resolving the major problems confronting the nation, province, district or local communities. The elderly need to be facilitated to strengthen the middle class, protect their human rights and improve their living conditions in a serious effort towards poverty reduction. Public and private efforts for providing old homes to eligible persons are praiseworthy but require to be institutionalized and replicated on a realistic basis with the collaboration of the relevant sectors, and close monitoring for any human right abuses.

As the newly elected government stands fully poised to establish the foundations of a welfare state with a focus on human development, it must not forget its obligations vis-à-vis its elderly population. The Federal Ministry of Human Rights also needs to make this an important dimension of their priority mandate assigning as much importance to the aging population as it needs to do for the implementation of the Convention on the Rights of the Child (CRC) or the Convention on the Elimination of all forms of Discrimination against Women (CEDAW). To do anything less, will not be befitting of a self-respecting republic in the twenty first century.

The writer is a senior public health specialist of Pakistan and can be reached at gnkaziumkc@gmail.com